Dr. Kayla Sample grew up wanting to be a veterinarian. As a Spanish and English speaker, she didn't realize until much later how beneficial being bilingual would be in her career.
"I am by no means as fluent as I want to be, and there's definitely medical terminology that I struggle with, but I feel that anytime a client has the ability to communicate in the language they prefer, the language they feel most comfortable with, that they are more likely to come to the veterinarian," Dr. Sample said. She is executive director of the veterinary clinic run by the Montachusett Regional Vocational Technical School, a high school program in Fitchburg, Massachusetts, that offers 21 different vocational programs, including veterinary science, alongside a high school education.
Across the United States, people speak an estimated 350 different languages. According to Access to Care, a report from the Pet Health Equity Program at the University of Tennessee, only 2.6% of barriers to veterinary care are related to language. However, language barriers may become a bigger issue over the next few years as the population of the U.S. continues to become more diverse. By 2044, more than half of all Americans will belong to a minority group and by 2060, about one in five of the total U.S. population will be foreign born, according to U.S. Census projections.
"Anytime we have any kind of barrier, we are creating a reason why animals do not receive health care. And so, whether that's financial, language, or transportation—whatever it is—my goal as part of the community outreach field that I am in is to reduce any barriers that we have and keep animals healthy and inhibit relinquishment," Dr. Sample said.
Meeting the need
Dr. Ruth Landau, owner of Dr. Ruth's Veterinary Services in the Indianapolis region, said communication can be difficult enough even when people speak the same language.
"I think being able to meet someone in their own language is very empowering. They're already coming in worried about their pet and not a native speaker. It's important to empower them," she said.
Dr. Landau is a house call and relief veterinarian. She received her doctorate in epidemiology and public health at Purdue University; her thesis was on the preparedness of veterinary professionals to work with non-English speakers. She describes herself as a communicative Spanish speaker with a high level of social and medical Spanish. Even still, Dr. Landau keeps a medical English-to-Spanish dictionary in her pocket and uses online resources such as Google Translate when necessary.
I think being able to meet someone in their own language is very empowering. They're already coming in worried about their pet and not a native speaker. It's important to empower them.
Dr. Ruth Landau, owner, Dr. Ruth's Veterinary Services
Dr. Landau led a study that investigated whether small animal veterinary personnel are prepared to communicate with Spanish-speaking pet owners with limited English-language proficiency. The study used a survey to obtain information from 383 U.S. veterinary practices in 10 states with large established or fast-growing Latino populations. Dr. Landau found that only 8% of the responding practices had staff that could converse in Spanish (J Am Vet Med Assoc 2016;248:690-699). Further, the responses showed that making Spanish-speaking staff available and offering Spanish-language resources were associated with an increase in the number of Spanish-speaking clients with limited English proficiency seen on a weekly basis.
Dr. Landau suggests hiring bilingual staff members if a practice has a high volume of clients who are non-native English speakers and always asking clients what language they would like to speak in and what language they would like their materials in.
Learning a language
Although more veterinary professionals may benefit from learning a second language, few veterinary colleges offer language courses.
Shannon Zeller, a Spanish curriculum developer and instructor at Colorado State University, said, "There's just so much to be done during a DVM program that including a language course is really hard." Zeller and Maura Velazquez-Castillo, PhD, a Spanish professor at CSU, helped develop a four-course series called Spanish for Animal Health and Care as a certificate program. CSU offers that series to resident undergraduate students and outside learners through its website.
Zeller and Dr. Velazquez-Castillo also collaborated with the CSU College of Veterinary Medicine & Biomedical Sciences on a series of four one-credit Spanish online language courses aimed at developing proficiency for future rural and mixed practice veterinarians. The series includes a 20-hour immersion course that is offered to third-year veterinary students and an introduction to Spanish for veterinarians that caters to students who have little to no Spanish coming into the veterinary college. Continuing education learners will be able to take the series starting in 2021.
Other veterinary colleges with language programs include Purdue University, which has a Spanish for Veterinary Medicine series consisting of student-taught lunch sessions.
"The Purdue University College of Veterinary Medicine's offering of the Spanish for Veterinary Medicine lessons are a part of a larger mission within the college to develop globally conscious veterinary professionals that are prepared to engage, exchange, and collaborate with the world around them," said William Smith II, director of global engagement at the veterinary college. "Along with improving one's overall Spanish language skills within a veterinary clinical setting, the lessons are designed to highlight the importance of communicating across cultures with the goal of effecting world change through the improvement of animal and human health."
Given how difficult it can be to study a foreign language during a veterinary degree program, CE may be the next best option.
AtDove, an online CE resource from DoveLewis, a veterinary emergency and specialty hospital in Portland, Oregon, has had two requests for materials specifically related to language barriers. The organization is in the process of building training tools that will include articles and links to resources.
DoveLewis has 12 bilingual staff members, including front desk staff and veterinarians, and two of the employees know American Sign Language. Staff at DoveLewis also use apps such as Google Translate and Linguava, a phone service translator, to better assistant clients who are non-English speakers.
On the farm
Large animal veterinarians, from those employed in and around the U.S. dairy and meat industry to those who work at racetracks or processing plants, frequently find at least some Spanish language skills necessary to do their job well.
According to a report from Texas A&M University, more than half of U.S. workers in the dairy and meat processing industries are immigrants. Many speak Spanish.
For Dr. Ashley Swan, a bovine veterinarian in Michigan, taking the initiative to learn a language was a good option. In her case, the decision to learn Spanish wasn't necessarily a skills-based one but a personal choice, she said.
"I was bored on the farm and wanted to be able to communicate more than saying 'open' or 'pregnant,'" Dr. Swan said. She took a Spanish language immersion course in Mexico and has been keeping up with it by watching YouTube videos and subscribing to magazines in Spanish.
"The biggest hurdle with any kind of language learning is just getting over that fear of not wanting to talk until you think everything's perfect," Dr. Swan said. "A lot of us, especially as adults, want to say these really nice sentences, but in reality, you've got to go through the stages of just stumbling through and talking. The best thing to do to learn Spanish is to speak it."
Veterinary leaders spoke about language barriers during the Banfield Pet Healthcare Industry Summit on Sept. 12 in Portland, Oregon. Banfield Pet Hospital launched an interpreter service pilot program in June at several California locations and at its headquarters call center in Vancouver, Washington. The service offers clients an over-the-phone interpreter in 350 different languages. The program has since expanded to 186 hospitals in California, Arizona, and New Mexico. It will be available nationwide next year.
Banfield implemented its interpreter service as a part of efforts to build a culture of inclusion and diversity for its clients and associates, said a Banfield spokesperson.
The company launched the interpreter program with guidance from Unidos, Banfield's associate-led Latino diversity resource group, according to the spokesperson. Banfield also recently relaunched a fully translated Spanish-language version of its website.
More than language
Although language may be a key piece to consider when a practice's client base is diverse, it shouldn't be the only thing. Some industry experts and veterinary colleges say the focus should be on providing culturally competent care, which is defined as providing care to a pet regardless of the owners' race, gender, ethnicity, background, English-language proficiency, or literacy.
Banfield, for example, suggests the following four items when working to develop cultural awareness: understand one's personal values and cultural beliefs, understand other's values and cultural beliefs, engage in cross-cultural interactions, and increase skills to gather more information about other cultures and assess differences.
Dr. Kayla Sample may have grown up with Spanish, but she is still working to enhance her skills, she said. She takes a night class to keep up with her language skills and she listens to a human-medicine podcast in Spanish to learn medical terminology.
She also understands how difficult it may be for veterinary students to include a language course within their four-year program. However, she does believe it is necessary for more veterinary professionals to be bilingual, and she hopes that people graduating from veterinary school will one day reflect the diversity within their communities.
"I just graduated, so I understand that we're trying to cram so much into their heads during those four years, but I also think it is a skill that is absolutely necessary," Dr. Sample said. "And so I don't have the perfect answer on exactly how we can bridge this gap, but what I do think we can do is start by building a team."
Tips for breaking language barriers
Some veterinarians suggest the following tips when thinking about learning a new language or working with a diverse clientele:
- Perform an inventory of the languages spoken within the community.
- Carry a bilingual or multilingual medical terminology dictionary.
- Consult a copy of "Small Animal Practice Client Handouts" by Dr. Rhea V. Morgan to help prepare client education handouts in Spanish.
- Listen to podcasts and audiobooks in another language.
- Take an online course.
- Use Google Translate or similar programs when necessary.
- Sign up for a language immersion course (if you have the means and time).
- Speak the new language as much as possible, even if it's uncomfortable.
- Place posters and brochures in multiple languages throughout the practice.
- Hire someone who is bilingual.
- Look at the client while you are speaking, not at the translator, when using a translator.
The AVMA offers several Spanish-language resources.
A booklet with humane educational activities and coloring pages from Maddie's Fund can be downloaded in English or Spanish.